The aim of this work was to perform an audiological evaluation on a group of children with autistic features and to correlate the results with the intelligent quotient, communication skills, and sensory integration function of these children.
Descriptive cross-sectional study.
The study was carried out on 25 Egyptian children with autistic features and 25 age-matched and sex-matched typically developing children. All the children’s age ranged from 4 to 9 years. All the children were subjected to the following: history taking, basic audiological evaluation, transient evoked otoacoustic emissions, N100, and P300. The children were also subjected to communication assessment, sensory integration dysfunction questionnaire, psychometric evaluation, and the Childhood Autism Rating Scale. The results obtained from the two groups were then compared. In addition, correlation studies were carried out for all the results obtained.
Autistic children presented with normal hearing sensitivities and cochlear function, and delayed N100 and P300 latencies and small P300 amplitudes compared with the control group. There was a significant negative correlation between N100 latency and verbal and nonverbal communication abilities. In addition, there was a significant correlation between P300 latency and amplitude and each of the following: intelligent quotient, the Childhood Autism Rating Scale, and dynamic assessment of verbal and nonverbal communication. The auditory and visual modalities of the sensory integration dysfunction score correlated positively with P300 latency but not amplitude.
The auditory deficits in autism involve controlled attention processes, speed of perceptual classification, and allocation of attention. N100 is a correlate of the level of communication and language development rather than a marker of autism. P300 abnormalities affect verbal and nonverbal communication, mental development, autistic features, and sensory integration function in autism and may be used as a tool to assess the prognosis of autism.
To conduct a prospective study investigating the causes of repeated recurrences of antrochoanal polyps (ACPs) in an attempt to minimize recurrence.
Twenty-two patients, with an established diagnosis of a recurrent ACP, were included in the study. A subjective visual analogue scale, endoscopic examination, and computed tomography, both coronal and axial, were performed preoperatively. Endoscopic sinus surgery was performed in all cases, combined with transcanine antrostomy in some cases, aiming at the complete removal of the polyp. Postoperatively, improvements in clinical symptoms and endoscopic findings were evaluated using visual analogue scale and endoscopic examination.
The study included 22 patients with recurrence of an ACP one to five times (a total of 38 previous surgeries). The endoscopic transnasal approach was used in 14 cases, whereas a combined endoscopic transcanine approach was used in eight cases. The success rate was 85.7% in the endoscopic transnasal approach and 100% in the combined endoscopic transcanine approach. All patients showed a subjective improvement after surgery but endoscopic recurrence was detected only in two cases after 18–24 months of follow-up.
The main cause of recurrence of ACPs is incomplete removal. Every effort should be made to completely remove the polyp (especially antral part) to avoid recurrence. Endoscopically, this can be performed using 30–45 and 70π telescopes, angled forceps, and performing a very wide middle meatal antrostomy and may be assisted with a canine fossa puncture. The operation preserves healthy antral mucosa and promotes epithelization and mucociliary clearance of the antrum.
Individuals from the Middle East or of Middle Eastern origins are increasingly seeking cosmetic nasal surgery as their traditional societies gradually become more exposed to the media. This is especially evident in the tribal communities of the Gulf, where financial issues are less of a concern. The Gulf States have also witnessed a rapid influx of foreign migrants over the last 30 years or so. This has resulted in a more racially and ethnically diverse population. The concept of ethnic rhinoplasty is gaining popularity. This entails resculpturing the nose to make it more acceptable within the patient’s own ethnicity and not to overcorrect or alter its characteristics to that of another ethnicity. The characteristic features of the Arabic nose, when exaggerated, are a good example where ethnic rhinoplasty techniques may be of value.
The aim of this study was to identify patients with exaggerated features of the characteristic Arabic nose, which are a long nose with a dorsal hump and a pendant tip. Subjective as well as objective measures including the clinical nasal index and the projection index were used to identify and quantify these anomalies. We will review some simple endonasal techniques for the correction of these perceived abnormalities for the best cosmetic as well as functional results.
Sixty four patients with typical Arabic nasal features underwent septorhinoplasty using simple endonasal techniques.
The majority of patients were very satisfied with their appearance after surgery. There were few minor complications with the techniques used.
Exaggerated features of the Arabic nose can be adequately corrected using a few simple endonasal techniques.
Pragmatics, the use of language in context, has been investigated only recently in the language of children who stutter. Some investigators have begun to address how the language and fluency of stuttering are influenced in different communicative settings. Some recent data have suggested that there may be a propensity for a delay or differences in certain areas of language learning for children who stutter compared with normal fluent children, specifically in vocabulary, pragmatic, or syntax development.
The aim of this study was to assess pragmatic skills in Egyptian Arabic-speaking children who stutter and to determine the relation between stuttering and the pragmatic aspect of language for future planning of a pragmatic-focused rehabilitation program for children who stutter.
The sample in this study included 20 Egyptian Arabic-speaking children diagnosed to have stuttering and 20 children with normally developed language who spoke fluently. Both groups were of average intelligence; their age ranged between 4 and 7 years. All were from the same socioeconomic strata and were selected from the outpatient clinic Kasr El-Aini Hospital. All participants were subjected to a pragmatic assessment and language assessment applied in the Phoniatric Unit, Kasr El-Aini hospital.
Scores of pragmatic skills were significantly lower in the stuttering group than the control group, except in object function skills. Preverbal communication skills decreased with increasing degree of stuttering and with an increase in Bloodstein stages of stuttering. Otherwise, other pragmatic skills showed no linear correlation with increasing degree of stuttering severity or an increase in Bloodstein stages of stuttering
Scores of pragmatic skills were significantly deficient in the stuttering group. All this should be considered during planning of a rehabilitation program for stuttering.
Communication is among the most basic of human needs. Verbal communication is the highest level of communication, whereas nonverbal (nonsymbolic) communication may remain the only mode of communication in individuals with significant cognitive limitation. Assessment of nonsymbolic skills of two categories of patients with limited verbal output, namely, those with autism [autistic disorder (AD)] and those with Down syndrome (DS), is our main aim. We used the Dynamic Assessment of Nonsymbolic Communication (DANC) test to achieve our aim, because most traditional language tests underestimate this type of communication. Insight into the nonverbal communication abilities of AD and DS patients helps to maintain the communication between them and their caregivers.
The current study recruited 20 patients with DS, 20 patients with AD, and 20 normal children as controls. The age of the AD and DS patients ranged from 2 to 5 years, whereas the age of controls ranged from 1 to 2 years. All participants were subjected to detailed personal, family, medical, and developmental history taking. Full clinical examination, hearing tests, and assessment of mental ability (intelligence quotient) were performed. The Childhood Autism Rating Scale was provided to evaluate the severity of autism. The DANC test was administered to evaluate the nonsymbolic skills of all participants.
The control group achieved the highest score in all parts of the DANC test, followed by the DS group and the AD group, respectively. There was no significant difference between the DS group and normal group (P>0.05), whereas the autistic group showed highly significantly lower scores compared with both the normal and DS groups (P<0.001). There was also a highly significant difference in scores on the DANC test among the patients in the autistic group in terms of its severity.
Application of the DANC test reflected a specific pattern of nonsymbolic skills of AD and DS patients with respect to their relative strengths and weakness. Such patterns should be considered while designing their intervention program aiming either at developing verbal communication or at enhancing the nonverbal skills. Maintaining communication with such patients helps to fulfill their simple needs and prevents frustration among their caregivers caused by lack of communication.
We report an extremely rare case of lateral nasopharyngeal cysts.
Case reports and a review of the world literature on lateral pharyngeal cysts are presented.
A 45-year-old male patient presented with a swelling in the nasopharynx. This swelling was oblong in shape, with a smooth bluish red surface with its inferior aspect projecting toward the oropharynx. Endoscopic nasal examination showed its attachment to be superior to the left side of the nasopharynx. Computed tomography scan axial cut showed a radio-opaque shadow of the cyst occupying the left half of the nasopharynx.
Congenital branchiogenic cysts of the nasopharynx are quite rare. They originate from the second pharyngeal pouch and attach to one side of the nasopharyngeal roof just behind the posterior choanal opening.
Nasolabial cysts are rare lesions present in the soft tissues beneath the ala nasi. Excision of the cyst through the sublabial incision is the most well-known treatment modality, with a low recurrence rate.
In this study, we discuss, through a literature review, the diagnosis, differential diagnosis, and a modified combined endoscopic and sublabial surgical technique for the treatment of this disorder.
Ten patients with a confirmed diagnosis of nasolabial cysts underwent combined endoscopic and sublabial enucleation of the cysts, and were followed up with a clinical examination and endoscopic assessment.
No recurrence was recorded during a follow-up period ranging from 3 to 12 months.
Nasolabial cysts can be enucleated with the use of a nasal endoscope to ensure complete excision.
The aim of this work was to study the correlation between communication skills, sensory integration dysfunction, and auditory brainstem response (ABR) findings in a group of children with autistic features in order to gain a better understanding of some of the communication deficits commonly encountered in these children.
The study was conducted on 25 Egyptian children with autistic features and 25 age-matched and sex-matched typically developing children. All the children’s age ranged from 4 to 9 years. Each child was subjected to the following: history taking, communication assessment, sensory integration dysfunction questionnaire, psychometric evaluation, the Childhood Autism Rating Scale, basic audiological evaluation, and assessment of ABR (20 and 70 c/s). The results obtained from the two groups were then compared. In addition, correlation studies of all the results obtained were carried out.
There were significant differences between the two groups under study in terms of communication skills, sensory integration dysfunction, and ABR waves III, III–V, V (20 c/s), I–V, and Vº (70 c/s). There was a significant negative correlation between ABR waves I and III and behavior, intentionality, capacity of symbols, reasoning, and total communication scores. There was a significant negative correlation between ABR waves III and V and forms, behaviors, intentionality, capacity of symbols, imitation, and total communication scores. There was a significant positive correlation between auditory sensory dysfunction scores and ABR wave V and waves III–V. There was a significant negative correlation between sensory integration dysfunction and intelligent quotient and communication skills. There was a significant positive correlation between sensory integration dysfunction scores and the severity of autism.
Some of the communication difficulties shown by children with autism might be related to sensory integration dysfunction. Auditory defects in autism may involve lower levels of neural transmission. Reducing sensory integration deficits can aid in minimizing some of the features commonly encountered in children with autism. This would also aid in further development of their sociocommunication skills. ABR, as an objective tool, may be used as a prognostic indicator.
We report 10 cases of paranasal sinus mucoceles with/without orbital/intracranial extension who presented to the Otolaryngology Department at the University Kebangsaan Malaysia Medical Center (UKMMC). The clinical presentation, pathophysiology, and the endoscopic and combined endoscopic craniofacial approaches in mucocele removal are discussed. The authors recommend the endoscopic transnasal approach as the main surgical treatment for paranasal mucoceles and highlight its outcome.
Scleroma is a granuloma affecting mainly the nose, and may extend to affect the pharynx, the larynx, the lacrimal apparatus, and many soft tissue structures surrounding the nose. In Egypt, as in many other Eastern countries, scleroma is the most common nasal granuloma diagnosed clinically and pathologically. Although it mainly affects the anterior part of the nose, it is not uncommon to find cases with extensive lesions that extend to occupy the entire nasal cavity, and also to the sinuses and the orbit. Active rhinoscleroma is usually treated medically, and surgical intervention is carried out in the fibrotic stage.
The aim of this study was to determine the role of CO2 laser in the management of extensive active rhinoscleroma.
This is a prospective study that included 24 patients with extensive rhinoscleroma in the active phase, that is, patients had almost complete nasal obstruction with mouth breathing. Patients were divided into two groups: group A (12 cases), who were managed only with medical treatment, and group B (12 cases), who were managed with CO2 laser debulking, concurrently with medical treatment.
Patients were followed up clinically for nasal blockage and histologically to assess the activity of the disease; group B showed earlier relief of nasal obstruction and needed less medical treatment to reach the inactive stage.
CO2 laser debulking is a good option in treating extensive rhinoscleroma, even in the active stage, as it provides rapid relief of nasal blockage and decreases the time needed for medical treatment, reducing the possible side effects of antibiotics.
Although apical petrositis has been typically managed with aggressive surgical intervention, the advent of antibiotics facilitated the conservative management of selected cases, however some resistant cases may still need conservative surgical intervention.
To present our experience with apical petrositis successfully treated via an infralabyrithine approach with the preservation of both middle and the inner ear after failure of aggressive medical treatment.
A retrospective study done by collecting the data of five patients with Gradenigo's syndrome who underwent surgical drainage by the authors via an infralabrynthine approach. The aim of this approach was to preserve the cochleovestibular function instead of translabrynthine approach as the five patients had variable degrees of pure conductive deafness without any evidence of labrynthine affection.
All patients started showing an improvement immediately after surgery, with the disappearance of diplopia and the lateral rectus palsy being the first outcome to be noted. In our series, only one patient developed mild vertigo and vomiting that lasted for 3 days, and was treated with sedation and antiemetics.
Infralabrynthine approach is a safe and direct way to drain inflammatory exudates from petrious apex.
Female teachers are at particular risk of developing voice disorders. They are more likely to have psychiatric disorders such as anxiety or depression.
To assess the presence of anxiety in female teachers with dysphonia, paying particular attention to the association between the patient’s self-evaluation of her voice handicap and anxiety state.
Thirty-nine female teachers with dysphonia were subjected to a voice assessment protocol, Arabic voice handicap index (VHI), to quantify the degree of handicap related to voice disorders and assessment of anxiety using the Manifest Anxiety Scale of Taylor. The results obtained were compared with the results of 34 normal female teachers who were subjected to the same assessment protocols.
There were highly significant differences between both the groups in the scores of VHI and the anxiety scale. Anxiety showed a significant correlation with the duration of dysphonia, the grade of dysphonia, the total score of VHI, and its three domains.
Anxiety is frequent among dysphonic female teachers, with a significant association between the patient’s self-evaluation of her voice handicap and anxiety state. Such a high association advocates for both vocal education programs and psychiatric consultations.
To evaluate the transnasal endoscopic marsupialization of a pediatric nasoethmoidal mucocele with intraorbital extension in terms of technique, difficulty, and surgical outcome.
Seven patients presented with a mucocele with intraorbital extension; they ranged in age from 8 to 14 years (average 11 years), and were treated using the transnasal endoscopic approach from March 2008 to March 2010. All patients underwent transnasal endoscopic marsupialization and were monitored clinically, radiologically, and endoscopically for a mean follow-up period of 15.3 months.
Postoperative nasal examination showed no findings with improved orbital manifestations in all cases. Also, nasal congestion, obstruction, and postnasal discharge disappeared completely. Postoperative computed tomography evaluation indicated a significant improvement on comparison with the preoperative computed tomography score. No major complications were found in the study.
Transnasal endoscopic marsupialization of a pediatric mucocele with intraorbital extension is a safe technique and can be carried out successfully. Combined intensive medical treatment with surgery is important in a mucocele with an orbital manifestation. Nevertheless, this technique requires good experience with the relevant anatomy in a pediatric age group.